Provider Demographics
NPI:1356926463
Name:ROESLER, MARY CATHERINE (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:ROESLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22719 CLEARWATER POINT RD
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-5619
Mailing Address - Country:US
Mailing Address - Phone:218-766-7068
Mailing Address - Fax:
Practice Address - Street 1:209 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3393
Practice Address - Country:US
Practice Address - Phone:218-829-3529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN864398163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse